Individual
SALLI JACOBSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6699 TORCH LITE TR, LOVES PARK, IL 61111
(815) 885-3202
Mailing address
6699 TORCH LITE TR, LOVES PARK, IL 61111
(815) 885-3202
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
06/11/2020
Last updated
06/11/2020
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